Look into Laparoscopic!!

I'm on a crusade! If you have not discussed a laparoscopic or laparoscopically-assisted hysterectomy with your doctor, please do so before making your surgery decision. For some women it is not possible, but for many it is an excellent alternative to abdominal hysterectomy. Please read on...

I'm 51 years old and was diagnosed with fibroids causing heavy uterine bleeding/anemia. After trying to bleed to death in early February (needed two units of blood and an emergency D&C), I was referred to an Ob/Gyn/Surgeon in my area. Until then, I had only needed my family practice doctor.

In our first meeting, we discussed my alternatives: Uterine ablation (with no guarantees to solve the problem) or a hysterectomy. I opted for a hysterectomy and he agreed, suggesting I also have my ovaries and tubes removed because he was certain that my ovaries had already stopped working. He then told me that he was skilled at performing laparoscopic hysterectomies and that he could perform my surgery that way.

I did my research on him (very impressive) and the technique. When I compared a recovery period of 5-10 days for a lap hyst, to 4-6 weeks for an abdominal, there was no turning back for me. At my pre-op appointment, the nurse who was taking my vitals, made a mistake and told me I was scheduled for an abdominal hysterectomy. That was a shock and, fortunately for her, an error.

When the surgeon and I spoke at the pre-op appt., I asked him about keeping my cervix. It had never been a problem, but I did not want to deal with mini-periods and Pap smears. I figured if I was going to have everything else taken out, I might as well get that out as well. We talked about the pros and cons and I still was unsure.

Since his original plan was to perform my hysterectomy totally via laparascopy, he asked me for permission to try to remove my cervix laparascopically, a procedure he'd been practicing for a year. He could not be sure that he could remove the cervix until he got in there. I thought about it for a few days, then told him to go ahead and try.

On the day of surgery, I signed a release that authorized him to perform a laparoscopic supercervical hysterectomy (leaves cervix in) or a laparoscopically assisted vaginal total hysterectomy (takes everything, including cervix, out thru the vagina) or a total abdominal hysterectomy (bikini or vertical incision). Again, the options needed to be there because he did not know what he might find when he went in.

I ended up with a LAVH because my uterus was 4 times larger than they had thought. They were able to remove it, intact, thru the vagina. I have four small incisions in my stomach. There are two 1/4" incisions with one stitch, one at each hip bone. There's one 1" incision with three stitches just above the pubic hairline. The fourth is somewhere inside my belly button and has no stitches. And yes, I assume there are lots of stitches on the inside.

My surgery was scheduled for 10 am and they planned to let me go as soon as I was able to "eat and pee". Unfortunately for me, I had an unusual reaction to the anesthesia and had to stay the night. I got out at noon the next day and have not had a bad day. I was prepared with two kinds of pain pills, but only took them the first day home because I thought "I should". From day 2 on, I took nothing. There was no pain from the surgery and I kept waiting for the "other shoe to fall".

My discharge instructions consisted of: No driving while taking narcotics (they consider Ibuprofen 800 to be narcotics) and no lifting or exercise for 2 weeks. I was told to make a post-op appt with my surgeon for 2 weeks after surgery; I'm actually scheduled to see him Monday, which will be 12 days post-op.

I live alone, in a 2-story house, and felt strong enough to take care of myself and carefully go up and down the stairs. I soon found that the stairs were no problemat all. I slept great the first night home, but the next night woke up about every two hours for no apparent reason. I've been fine with sleep ever since. I drove to work on day three and did a couple hours work, then went to a friend's house for dinner and a video.

The "other shoe fell" when the gas pains started in about Day 4. A friend of mine told me to get anti-flatulant pills and I did. They helped with the gas, but now my "shoe" is the pain associated with BM's. From this website, I've learned this is normal regardless of the type of hyst you have. I've never given birth to a baby, but I think this pain might come close. Real eye-crossing pain that I'm assured will go away soon.

I'm now 10 days out and feel fine. I can tell that things are healing on the inside. There are pinches and dull aches, but no pain to speak of. There is some minor pinkish/brown discharge from the vagina as my stitches begin to dissolve, but this comes and goes quickly.

I plan to go back to work after my doctor appointment Monday morning. I will let you know if that does or does not happen, but I expect no surprises.

I encourage everyone to look into this procedure during your trip into the Land of Hyster. If your doctor is not aware of it, or does not seem interested in offering it to you as an option, please seek a second opinion.

My best to each and everyone of you.

Hi, Anita...

It sounds like you had a really great experience with your LAVH! I've heard of docs trying to remove the cervix via lap, but have never come across anyone who's had it done that way. Your doc must be very skilled.

I'm pretty sure that all docs are aware of lap surgery. Many are trained to do it, but not all (or even most). A good doc who does not have training in laparoscopic surgery should not be offended if his or her patient is a good candidate, and wants a referral to someone who does this kind of surgery. But, as you mentioned, many women are not good candidates for lap surgery--especially if they have cancer, adhesions, endometriosis, etc. And lots of women on this site do have those conditions. If a woman's condition is complex enough to not *clearly* warrant a lap surgery, I strongly believe she should go with the recommendations of a doc she really trusts. And, get those other opinions, too, like you said.

Though lap surgeries are much easier to recover from, the best way to insure good health in the future is to follow the advice of the best doc you can find, no matter what kind of surgery it is they recommend. And if it's lap, go for it! But if a doc you really trust doesn't feel like lap is the route for you, I wouldn't go searching for someone else who would be willing to do it.

I'm glad this has worked out so well for you! I just wanted to add that the amount of pain that you experienced with your LAVH seems much lower than what is typical. Most women aren't as ready to resume normal activities as quickly as you and *do* require those pain meds. Some women who have the LSH leave the hospital the same day, but it is highly unusual for a woman who has had an LAVH to be released that soon.

I'm glad you're feeling so great. But, please do be careful. Even though it may not feel like it, there's a *lot* of healing going on inside you right now...I wouldn't want you to mess that up!

Hugs,

Margot

Hi Anita

I’m glad you had a good experience with your surgery and recovery. I had LAVH and have been pleased with my experience also. Mine took 5 hours due to the severity of adhesions and endo we didn’t know I had. My surgeon could have switched to the abdominal approach at that point, but proceeded with the LAVH because he is very comfortable with the procedure and he feels the magnification on the lens aids in visualizing smaller areas of endo. Because of the severity of what he found, my surgery was more extensive than planned so my experience may not be typical – but that’s the hitch… none of us can know ahead of time what our surgeries will be like or what the docs will find once they’re in there or whether we’ll suffer any complications. I awoke from my LAVH surgery in horrible pain. When asked to rate it on a scale of 1 to 10…. I vividly remember giving it an 11!

I spent 3 ½ miserable days in the castle. I had to stop narcotics after a couple of days due to severe itching, not because I didn’t need them. I did feel much better a few days after being home and within 1 week I felt pretty good. I am very comfortable with my Dr. and this is a procedure he is very skilled with, but to me the surgeon I was dealing with was more important than the surgery type. I was told I should have less incisional pain and smaller scars with typically a shorter hospital stay even though the surgery can sometimes take longer, requiring more time under anesthesia. I’m sure I would have had even more pain if I had an abdominal incision to deal with, but I was in so much pain at the time I can’t imagine it being any more off the chart than it was. For me, I think the advantage was clearer around the one week mark, when I was feeling better and moving without incisional pain, where a TAH sister would probably still be dealing with that issue. There are many other women who’ve had a very good experience as you have & I’m not saying mine was bad… it just wasn’t easy.

There are advantages and disadvantages to each method and it’s good to hear other experiences. I agree a 2nd opinon before major surgery is a good idea.I wouldn’t have specifically requested laparoscopic though. I only wanted my doc doing what he felt most comfortable with for my situation. I try to be careful sharing “my LAVH experience” as just that – "my experience” because I’d feel badly recommending it if things didn’t turn out as well for another sister.

Take it easy during your time of healing & remember you still had major surgery even though you don’t have a major abdominal incision. I hope you continue to do well with your recovery.

Best wishes & s,
Beth

Hi Anita,

I am one year post-op from my LSH and I could not be more pleased with my surgery results. Lately, I have been wearing several pairs of jean shorts I own for summer - but now - I am wearing them comfortably. No tightness because of a protruding stomach from fibroids.

In my opinion, it is a good idea to get a 2nd or 3rd opinion and make sure one is a ~good~ candidate for their type of hyst. My 1st Dr. wanted to do a TAH due to the size of my fibroids and my 2nd Dr. recommended a LSH after I did (3) months of lupron shots to shrink my fibroids enough for surgery. I am very glad I was a candidate for a less invasive hyst.

Best wishes and thanks for your post. I am pleased when laparscopic ladies can post with good results.

Mary

To all who replied -

I had my ultrasound yesterday & have several fibroids including one about golf ball size. My uterus is about the size of a 3 mo pregnancy (lg grapefruit/sm cantaloupe). I am having frequent bleeding, light-heavy, various times throughout the month. I have some serious cramping to go along with it & the waist bands of my pants are getting tighter. I am 39, have never had kids & had a tubal ligation when I was 35 (birth control made me nuts) - so, in view of this, my dr & I agreed that a hysterectomy would be the best alternative - since my ovaries are in great shape they'll be spared. However, she told me that an abdominal hysterectomy would be the only way considering the size of the uterus - this makes no sense to me. Babies are delivered through the vagina at 9mo - why can't a 3mo bouncing baby uterus be delivered the same way? Has anybody run into this problem? I just don't see the need to cut!

Well, as I wrote this, I received a call from a nurse at a women's center in my area. Luckily, with the direction of hysterectomyoptions.com I was able to locate a physician in my area that specializes in MIP (minimally invasive procedure) hysterectomies & I called to discuss my concerns. She, of course, could give me no guarantees, but said I was right question the 'cut first ask questions later' approach & said her own experience with the drs she works with was extraordinary. I've made an appt to get my 2nd opinion & I'm keeping my fingers crossed.

I believe I'm on a better road now than I was when I began this message, but I'd still like any experience input I can get.

Thanks sisters
STRUTTN

Struttn,

Note that there are several types of Laparascopic minimally invasive procedures:

1. Laparascopic Supracervical Hyst- all work is done through the abdomen (belly button and 3 small other cuts). Cervix is not removed, and uterus is removed via a morcellator, that grinds it up and pulls it out through small cuts in the abdomen area.

2. Laparoscopic Total Hyst- Same as above but cervix is removed.

3. Vaginal Laparoscopic- entry through vagina, but laparoscopic camera placed in belly button. Cervix will be enlarged in this, as uterus needs to be pulled through the cervix to remove it.


#1 and #2 may be options for those who want a less invasive approach than another abdominal procedure, such as Total or Subtotal (supracervical) Abdominal Hysterectomy.

I posted an article showing outcomes of Laparoscopic Supracervical- it stated that there were 3 conversions to abdominal hysterectomies- 1 for an extremely overweight person (300 pounds), and 2 others for very large uterus size.

So someone with a very large uterus size may not be able to find a surgeon willing to try a laparoscopic procedure on them, or may state to the patient that they will try to do it laparoscopically, but may need to convert to an abdominal procedure during the operation if the laparoscopic approach isn't working.

It would be more complicated for a larger uterus even if a surgeon were willing to try it; perhaps a surgeon at a major medical center would be more willing to try it than one at a smaller hospital.

However, someone who is not severely overweight or does not have an extremely large uterus size should certainly investigate it prior to committing to the more invasive abdominal procedures.

-Torrie

Torrie,

Hi!! Can you tell me where you posted that article about laparoscopic hysterectomies? I once questioned my dr about having one and he said point blank that my uterus is too large (approx. 17 - 18 week pregnancy size). I would love to see your article to see exactly what "too large" is. I haven't scheduled any surgery date yet because I'm too terrified of having my abdomen sliced open. I'm just a big baby!!! I am, however, open to the idea of laparoscopic surgery. Thanks!!

ablumny,

I posted it on 6/16; here is the reference to the abstract. I've only read the abstract, but I'll try to see if I can reference the article through our medical college to see if it says exactly how large the uteruses were that they were not able to extract laparoscopically. That would give some indication of what the limit is.

You may also want to try to get a surgeon who is not your regular doctor; you are in Long Island so perhaps you could contact the gynocolology clinic at one of the major medical centers in Manhattan to see if they have any surgeons who might be willing to try a laparoscopic procedure on a "large" uterus; usually the gynocological surgeons at major medical centers have more experience with "difficult" procedures than an ordinary clinical gynocologist would.

Authors: Morrison JE ;fr. Jacobs VR.
Title: 437 classic intrafascial supracervical hysterectomies in 8 years. Source
Journal of the American Association of Gynecologic Laparoscopists.8(4) 558-67,
2001 Nov. Abstract


-Torrie

Ablumny -

Also try that site I mentioned in my first message - www.hysterectomyoptions.com. You simply enter your zip code to find a specialist in your area.

I found a specialist in MIP hysterectomies within 6mi of my house - spoke with one of his nurses yesterday. She said she was so happy that I took the time to look around and ask questions - I'm hoping it'll save me some pain in the long run.

Torrie -

I really want to thank you for all the information - I'm going back to look at your previous posting. I'm just like Ablumny - a big baby - but knowledge is power. Thanks again - at least now I have a reference point.

STRUTTN

ablumny,


Since you are in Long Island, I checked if Columbia University indicated which physicians perform laparoscopic surgery. They do indicate this; here is the link to their physician lookup page.

http://asp.cumc.columbia.edu/facdb/f...scopic+Surgery

These might be some physicians to at least inquire of, if your insurance would cover them.

Yes, Struttn, knowledge is power :-)

-Torrie